Teaching theoretical nursing

William Lauder

Nursing science has been described as being either alive or inert. Acceptance of
one or the other paradigm has important implications for the way in which
theories of nursing are taught in the curriculum. In this paper these conflicting
paradigms are discussed and the implications for nurse teachers are outlined. It is
suggested that this may involve a reconceptualisation of where nursing theories are
derived and a consequent shift of power from nurse teachers to the practising
nurse.

study. They state that ‘the term science (in this

THE PHILOSOPHY OF NURSING sense) refers only to a product i.e. a set of
SCIENCE: PROCESS OR PRODUCT statements that purportedly constitute the body
of knowledge. The product includes scientific
In his paper on the relationship between theory terminology and definitions, propositions,
and practice in nursing, Desmond Ryan (1988) hypothesis and laws’ (Silva & Rothbart 1984, ~4).
describes science as having a dual nature. This Science itself is therefore a body of knowledge
duality is at the heart of the theory-practice that includes a variety of research methods and
debate. Ryan describes science as being both philosophical values that govern the develop-
alive and inert. Science views knowledge as an ment and justification of nursing theory.
achieved structure whose knowledge is there- If one accepts this paradigm the student
fore static and certain. The product is the valued should learn the terminology, definitions,
goal for those studying this type of science, on hypothesis, theories and laws of one or more
the other hand live science is a process of nursing theories. Logical empiricists value this
questioning and challenging the boundaries of product more than the process one must go
received wisdom. The living scientists does not through to attain it (Parse 1981). The second
simply apply science but draws on it to solve approach to teaching nursing theory can be
problems in a creative and flexible manner. called the process approach. In this approach
The product paradigm has its roots in the the nuts and bolts of a theory are less important
philosophy of science called logical empiricism than the cognitive skills that may be developed
(Silva & Rothbart 1984). The logical empirical whilst studying theory or the ability of the
view of nursing science does not understand it in working scientist to draw on theoretical work to
terms of working scientists but views science as a solve the problems of practice.
compilation of data derived from empirical This scientific duality characterises the two
main approaches to the way nurse theory is
William Lauder RMN DipN (CT), Nurse Teacher, taught. It seems critical that teachers of nursing
Highland College of Nursing and Midwifery, identify which paradigm will guide the way in
Raigmore Hospital, inverness, IV2 3VS. UK
(Requests for offprints to WL)
which nursing theory is included in the cur-
Manuscript accepted 29 October 1991 riculum.
66 NURSE EDUCATION TODAY

The product paradigm Meleis and Price (1988) are two nurse theorists
who claim that the very act of separating nurse
The notion that the theory itself should be the
theory from other parts of the curriculum has
main concern of nurse teachers and students is
created many of the myths that surround theory.
arguably the predominant paradigm in nursing
Furthermore it has encouraged students to
today. Within this paradigm there is some debate
compartmentahse theory as something distinct
as to whether we teach one theory or many.
from practice. Students learn the business of
Smith (1987) crystallises this debate when stating
care from non-nursing theories without being
that, the critical decision facing nursing is ‘to
able to create connections between theory, prac-
what extent are nursing models to be taught in
tice and research. This form of structuring
the curriculum’ (~113). She outlines three
knowledge can be described as being socially
possible alternatives:
organised. Theory has been in a sense misappro-
The curriculum is arranged so that all the priated by teachers as something which is the
content and teaching/learning strategies property of the classroom. In essence nurse
reflect only one theory. teachers may have been responsible for creating
The curriculum should contain informa- the practice-theory gap in an effort to maintain
tion on nursing theories but this is not their status by promoting the value of de-contex-
integrated into mainstream curriculum. tualised knowledge at the expense of practice-
The content on nursing theory is taught based knowledge. In an effort to achieve acade-
explicitly with experiences organised mic credibility nurses have sought to create a
around a particular theory(s). body of free standing knowledge and underva-
lued that created by the practising nurse (Ryan
Roberts (1985) sees advantages in the first 1988).
alternative and argues that nurse education The third option seeks to cross the practice-
should take place round a clearly identifiable theory gap by integrating both within a theory.
theory of nursing. Many educationalists believe Aggleton and Chalmers (1987) suggest that
that a theory of nursing would provide a struc- having accepted a theory for this purpose, the
ture that would make curriculum planning theory will then determine what is to be taught,
easier (Lawrence&Lawrence 1983). Ryan (1988) how teaching and learning take place and how
is critical of this view and regards it as viewing success can be measured. Although these
nurse science from the teachers perspective. He authors have attempted to cross the gap, their
describes this approach as a teacher-structured science is still fixed, static and determined by a
body of knowledge that must be covered in the particular theory. The student is required to
time allocated and that the student must note, absorb and assimilate this knowledge. This
learn and reproduce. Many nursing theories approach restricts the freedom of the student to
were in fact originally intended to be used in explore a whole range of options by removing
curriculum design and formed part of the 1970s the freedom and creativity to make decisions on
movement in America which legislated that all problems in the face of the practicalities that
nursing courses should be designed around an determine them (Ryan 1988). Ryan would
identified theory. regard these approaches as the transmission of
The second option is to teach a self-contained inert theory, a type of theory which often func-
course in nursing theory. This is another popu- tions at the level of anti-educational dogma.
lar way of including nursing theory in the Price (1989) has levelled this charge at higher
curriculum, especially in the United States of education, when he suggest that universities and
America. Botha (1989) advocates this pluralist polytechnics must be helped to break out of the
approach when she suggests that nurses should routine of decanting out of date knowledge into
be exposed to as many models ‘as can be possibly their students. It is arguable that if we wish to
and pedagogically fitted into a curriculum’ have creative problem-solving nurses the pro-
(p49). duct paradigm is not the paradigm of choice.
Nursing theory-the process of of subjects but on the logic of learning. Whilst it
living science _ would seem highly desirable to focus on the logic
learning, it is neither desirable to ignore the
The other side of the scientific dualism would product of learning.
view nursing theory not as inert but as a living Student nurses must acquire certain skills and
and changing process. Chinn and Jacobs (1978) knowledge in order that they are safe and
propose that nurses accept such a paradigm in competent practitioners. Evans ( 1980) a collea-
their model of theoretical development when gue of Burgess makes exactly this point when he
they suggest that the process of developing a comments that theoretical knowledge is to be
theory and not a specific outcome should be learned at the same time as ‘course process’.
emphasised. Clearly these nurses give priority to These views are especially interesting to nurse
the process as opposed to the product. education as the new Project 2000 course carries
Newman (1983), a proponent of the process the academic award of Dip HE.
paradigm, supports this view when she argues
that nursing science is a process of knowing,
Theoretical nursing - how should it
challenging and a continuous revolution. Nurs-
be taught?
ing theory is constantly evolving and is not
enshrined in tablets of stone, therefore its con- The notion of scientific knowledge as a continu-
tingent and relative nature should influence the ally evolving process, upon which nurses draw to
way in which it is taught to students. The idea solve the day to day problems of practice, has
that nursing theory is a continual process of important implications for nurse teachers.
questioning, of pushing back the frontiers, of If nursing is to accept the process paradigm we
action and a search for knowledge are the require to reframe the central question of nurse
characteristics of ‘living theory’ (Ryan 1988). education (Meleis & Price 1988). The question of
Silva and Rothbart (1984) believe that nursing how do we teach nurse theory?, becomes how do
is in the process of moving from the product to we facilitate the development of theoretical
the process paradigm. This paradigmatic shift is nursing? These nurses define theoretical nur-
vital if the theory-practice gap is to be closed. sing as ‘the theoretical statements that guide
Nursing should not be closing doors to theoreti- nursing practice, that provide direction to nur-
cal growth by wholesale acceptance of one epis- sing research and that constitute the propo-
temological perspective to the exclusion of sitions that answer its pressing questions’ (Meleis
others. We require to adopt an open view of the & Price 1988, p 593).
world, how we come to know it and our place in Theoretical thinking has been said to stimu-
it. ‘l‘his is made even more urgent if we accept late creative thinking, to guide the application of
Cull-Wilby and Pepin’s (1987) claim that nursing research, identify nursing phenomena and assist
has only recently sought scientific status and still in the recognition of the value of theory (Reed
has much room for growth. 1985). It allows students to take responsibility for
l‘he process paradigm was the basis of the their own learning an ability that is though to be
curriculum design of the first Diploma in Higher a liberating experience (Gowin 8c Novak 1984).
Education (DipHE) introduced at the North East It is argued that, once students have
London Polytechnic (NELP). In this course, developed the ability to think theoretically, they
primary importance was placed on method of can assist in the further development of personal
learning and not on the learning of facts or any and professional knowledge. The emphasis
ordered group of facts (Burgess 1988). Burgess when developing theoretical thinking should be
argued that the original concept of the DipHE on the ability to use theoretical knowledge
within the school of independent study at NELP creatively to solve the problems of care delivery.
was radically different from other higher edu- The idea that theory must assist the practitioner
cation courses. This innovative course was based to solve her care problems and that practice can
not on subject disciplines or upon combinations be a source of theoretical knowledge can help
68 NURSE EDUCATION TODAY

create bridges between practice and theory. Real Botha M E 1985 Theory development in perspective:
theory can be described as the systemisation of the role of conceptual framework and models in
theory development. Journal of Advanced Nursing
what practitioners are continually learning from 14: 49-55
experience. This forces nurse teachers to ques- Burgess T 1988 In: Robbins D (ed) The rise of
tion the belief that they teach theory and prac- independent study. Society for Research in Higher
Education, London
titioners simply put that to use. Practising nurses Chinn P, Jacobs M 1983 Theory and nursing: a
must see themselves as theorists whose theoreti- systematic approach. C V Mosby, St Louis
cal knowledge is to a large extent derived from Cull-Wilby B L, Pepin J I 1987 Towards a co-existence
of paradigms in nursing knowledge development.
their everyday experience of caring. The trans- Journal of Advanced Nursing 12: 5 15-52 1
fer of this responsibility requires nurse teachers Evans D 1988 In: Robbins D (ed) The rise of
to accept that they are no longer the source of independent study. Society for Research in Higher
Education, London
theoretical knowledge in nursing and accept the Gowin D B, Novak J D 1984 Learning how to learn.
consequent shift of power and prestige that Cambridge University Press, Cambridge
accompanies the possession of knowledge. Lawrence S A, Lawrence R M 1983 Curriculum
development: philosophy, objectives and conceptual
Benner (1984) supports this view when she framework. Nursing Outlook 31 (3): 160-165
suggests that recognising the importance of Meleis A 1985 Theoretical nursing development and
knowledge embedded in practice empowers the progress. Lippincott, Philadelphia
Meleis A, Price M J 1988 Strategies and conditions for
practitioner. teaching theoretical nursing: an international
The challenge facing nurse teachers is to perspective. Journal of Advanced Nursing 13: 592-
develop teaching strategies which facilitate the 694
Newman N A 1979 Theory development in nursing. F
development of theoretical thinking. Many A Davis, Philadelphia
believe there are few if any teaching strategies Parse R 1981 Man-living-health: a theory of nursing.
for teaching theoretical nursing (Meleis 1985; Wiley, New York
Price C 1989 Academics and society: freedoms seamless
smith 1987). Even if this worst case scenario is role. In: Ball C, Eggins C (eds) Higher education into
the case it should only act as a catalyst to speed up the 1990s (new dimensions). Societv for Research in
the development of such teaching strategies. Higher Education, London ’
Reed P C 1985 Strategies for teaching nurse research:
theory and meta-theory in an undergraduate course.
Western Journal of Nursing Research 7,4: 482-486
Ryan D 1988 Theory and practice in the modular
scheme. National Board for Scotland.
Silva M C, Rothbart D 1984 An analysis of changing
trends in philosophies of science on nursing theory
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